What’s the cure for Ontario’s doctor gap?

By MPP Toby Barrett

Few will argue we have a doctor shortage in Ontario, including right here in Haldimand-Norfolk. Some will say it’s a crisis as thousands rely on walk-in clinics and emergency rooms for primary care.

Family physicians establish, in most cases, close relationships with their patients close to home. They are in a position to foster health promotion and coordinate the care provided by specialists. A strong primary care system can reduce overall health costs and improve better health outcomes.

This past spring, my office was inundated with calls after a long-time family physician announced he would retire. While my office can advise where to look for a replacement, they cannot assist in recruiting doctors or asking the Ministry of Health to put one person ahead of another.

The retiring physician practiced under fee-for-service, and cared for 4,600 patients. New graduates prefer to care for an average of 1,200 to 1,800 patients. With a population of 65,000 and an average of 1,500 patients per doctor, Norfolk County alone would require 43 family physicians – we currently have 29.

Since the early 1990s, there’s been a growing trend whereby medical students are increasingly reluctant to specialize in family medicine. In attempts to address this reluctance, Ontario began experimenting with alternative payment models, various forms of group practice, and increased the role for nurse practitioners, pharmacists, and other health care professionals.

There are three basic models for primary care delivery: fee-for-service, capitation and salary. For the most part, Ontario’s physicians are compensated by a combination.

Today, more than 75 per cent of Ontario’s physicians work in some form of group practice – Family Health Groups (FHGs), Family Healthy Networks (FHNs), and Family Health Organizations (FHOs). These groups all involve three or more doctors practicing together in either the same office space or in close proximity.

The main difference among these models is the method of payment. Those in FHGs receive fee-for-service with additional incentives, and must commit to extended hours of care. Doctors in FHNs and FHOs receive a lump sum per patient, plus bonuses and incentives, and must commit to enrolling patients and providing extended hours of care.

Community Health Centres were developed in the 1970s to deliver primary care to communities typically underserviced. Ontario now has 75 CHCs operating, including the one in Delhi.

Back in 2005, Family Health Teams were introduced to provide comprehensive primary care to more Ontarians. Currently, there are 184 teams made up of doctors, nurses and other providers such as mental health workers, nutritionists and social workers. Doctors on these teams can receive either salary or capitation-based compensation.

As well, Ontario has 25 Nurse Practitioner-Led Clinics.

While the government considers these changes to primary care as improvements, they have come at a cost. Total payments to physicians rose from $2.8 billion in 2006-2007 to $4.2 billion in 2012-2013, — an increase of 50 per cent.

Since January, I have been asking the Minister of Health for advice or help for our underserviced area. I was heartened to learn Norfolk County, in May, was designated as a high physician need area. This designation lifts the freeze on physicians starting or joining FHOs.

Determining which compensation model is in the best interest of the physical and financial health of taxpayers may take years, — our immediate concern is ensuring Haldimand-Norfolk has access to quality health care close to home.